First Name

Last Name

Date of Birth

Address

City

Zip

Home Phone

Cell Phone

Marital Status (Mark all that apply):
Single Married Widowed Separated Divorced

Name of Spouse (If Married)

Anniversary Date (If Married)

How long have you attended Riverview Church?

Have you ever been under church discipline?
Yes No

If yes, please explain.

Please briefly describe your understanding of the Gospel and what it means to follow Jesus.

If you were to die tonight and were to appear before God and he should ask you, "Why should I let you into my heaven?" How would you answer?

How do you see Riverview Church helping you grow in your walk with Jesus?

Where do you see yourself fitting into the body life of Riverview Church? How do you plan to serve and contribute?

Are there any questions about Riverview Church that you would like answered or clarified?

Have you been baptized as a believer?
Yes No

If yes, when and where?

Having read the Riverview Church Constitution and Relational Commitments, do you agree to abide by the content contained therein as a member of Riverview Church?
Yes No